Thursday, October 15, 2020

Building Resilience During the COVID-19 Pandemic

Dating back to our earliest times, humankind has experienced the psychological impact of a wide range of catastrophes, including famines, floods, earthquakes, wildfires, windstorms, wars, and, last but certainly not least, outbreaks of potentially deadly infectious diseases. We are certainly no exception today as people try to figure out how to cope—and help others cope—with the grief, stress, and anxiety caused by biggest health challenge of our time: the coronavirus 2019 (COVID-19) pandemic. With more than 215,000 Americans having lost their lives and more than 7.8 million infected since COVID-19 first gripped our nation, the pandemic has taken a profound psychological and emotional toll on us all. Still, behavioral and social science researchers have identified some strategies to help us deal with our fears, and even rise to the challenge of supporting others during this unprecedented time. Recently, I had an opportunity to discuss the science behind mental health responses to disasters with Dr. George Everly Jr., a psychologist and professor at the Johns Hopkins University Bloomberg School of Public Health, Baltimore. A world-renowned expert with more than 40 years experience studying the psychological impacts of disasters, he co-founded the International Critical Incident Stress Foundation, an organization affiliated with the United Nations. Our conversation took place via videoconferencing from our home offices in Maryland. Here’s a condensed transcript of our chat: 

 Collins: Good morning! At NIH, we are doing everything we can to keep our scientific mission going by supporting groundbreaking research into COVID-19 and a lot of other things. We’re also deeply committed to helping people manage stress and attend to mental health. So, we’ve invited Dr. Everly to share insights that I believe will help us learn some skills to build resilience. Goodness knows, this is a time where we all need resilience, as well as to help others around us. We’re all called upon, I think, to look after our friends and neighbors in the aftermath of a circumstance like the current pandemic. 

 Everly: It’s a privilege to spend some time with you today and chat about such an important topic. The topic we typically think about in terms of disasters is the physical response. Today, we’ll talk about the psychological impact of the COVID-19 pandemic. This is actually my third pandemic, having consulted in Hong Kong with SARS and Singapore with H1N1. I’ve also done consulting with Ebola. However, I will tell you that this pandemic, COVID-19, has been the most challenging. I think we can we agree that mental health is an intrinsic value as it relates to us as humans. Anything that threatens mental health, especially in large numbers, threatens the core fabric of society. According to the United Nations, we may now be looking at an impending international mental health crisis. Some have called this the “hidden” pandemic: people who previously coped well may have challenges and people who had challenges coping before COVID-19 may have increased challenges. Looking at first responders and frontline workers, we have seen heroic efforts on their part, but not without consequences—and mental exhaustion may be one of them 

 Collins: How is this crisis similar—and how is it different—from most of the disasters that people have dealt with? 

 Everly: The first thing is expectations. If we expected COVID-19 to be short lived, we have been remarkably, if not catastrophically, disappointed. So, this connection occurred to me. A number of years ago, I was interested in the psychological impact of the London Blitz, and I went to England to interview people who went through that night upon night upon night of intractable bombing during World War II. I wanted to find out what helped people make it through. It was very clear that their initial belief that the bombing would be short-lived was tragically violated. They then as a community understood that they had to shift into a different mindset, and realize the Blitz wasn’t a sprint—it was marathon. They’d originally sent their children out into the countryside, but later decided to bring them back in the midst of bombing. I will suggest that psychologically, that was the turn of the war. In fact, research later by Anna Freud found that sending the kids away was psychologically more injurious than keeping them in the city. And I think that’s really important. Realizing that we are in for a long haul with COVID-19, in and of itself may be a game changer. 

 Collins: A very interesting comparison. I hadn’t thought about it that way—an acute disease becoming chronic. Tell us a little bit more about the undercurrent of malaise in our country even before this COVID-19 pandemic hit—what economists Angus Deaton and Anne Case have recently written about as the “deaths of despair” and the opioid crisis. We are facing a pandemic from coronavirus, but it didn’t land on a completely blank page. It landed in a circumstance where many people were already feeling significant stress, and where depression was increasing risks of overdoses and suicide. 

 Everly: Fantastic question. You probably remember the work of Hans Selye, an endocrinologist who actually coined the term “stress.” He said, at any given point in time, we have a limited supply of what he called “adaptive energy.” In the best of conditions, this reservoir is quite high and will allow us to meet unusual challenges. However, I would suggest that the background noise of chronic issues that predated COVID-19 did begin to deplete that reservoir of adaptive energy, making us more vulnerable to things that turned out to be far more challenging than we thought. We were starting with one foot in the hole, so to speak. 

 Collins: All the more reason why our resilience is being called upon. Piled on top of it, many people are facing the serious challenge of trying to telework from home and trying to manage their responsibilities in terms of children or other family members who need care. My heart goes out to those folks as they struggle with this shared set of responsibilities, probably feeling as if there aren’t enough hours in the day and distractions are always getting in the way. People are also feeling stressed now about the health of their children. What do we know—and what should we be thinking about—in terms of the mental health impact of the COVID-19 pandemic on kids? 

 Everly: In the spirit of full disclosure, I’m not a child psychologist. But I have studied trauma, crisis, and disaster for quite a while, and, invariably, children are part of that. One of the most powerful things I have seen in my career is that children often become reflections of their parents. Children not only desire, but they need, stability. My message to parents is that your children rely on you. You must be that strength for them. Even when you think you can’t be strong for yourself, reach down deep inside and say, “This isn’t just about you; it’s about others as well.” I’ve got three young grandchildren, and this is the message I am telling their parents: “This is an important time. This may be one of the defining milestones in your children’s development. It’s an opportunity to show them how to cope.” 

Collins: I have grandkids as well and have been watching how they have adapted. In some instances, I can see how they have actually gained in strength, as they’ve learned that this is an opportunity to face up to a challenge and learn how to cope. It does seem to be a mix of providing that foundation of support, but trying not to prevent children completely from having the experience of realizing they can get through some things themselves. 

 Everly: We can certainly be overprotective. From studying Olympic athletes, we learned that when they were asked what helped them reach the elite tier and win Olympic medals, they answered: challenge, plus adequate support. While well-intended, I think support alone is misdirected. 

Collins: That makes sense. I know, during the current crisis, there is an interest in figuring out, in scientifically rigorous ways, what mental health interventions seem to produce good outcomes. Tell me a little bit more about where we stand as far as the opportunities to be doing these sorts of trials of various interventions. It would be a shame to go through this and then say to ourselves, “We missed a great opportunity there to learn more.” 

 Everly: It’s tough to do a randomized, controlled trial in the middle of a disaster. There are quite literally ethical issues at play. So, we approximate as best we can. For example, in the past, we built our own model of Psychological First Aid and tested it in two randomized controlled trials and three content validation studies, as well as in structural equation modeling studies. Have we tested it in this current environment? Not yet. There may be others doing that—I’m not sure. If you take a look at the Cochrane Review on resiliency programs, you will perhaps be a little surprised. The review says there’s not a compelling body of evidence that resiliency programs work. However, we believe they work. We know there is this thing called human resilience and we encourage everyone to keep on trying to study it in scientifically rigorous ways. 

 Collins: I’m glad that you are. We should not miss the opportunity here to learn, because this is probably not our last pandemic—or our last crisis. Any final words? 

 Everly: So, with the caveat that I’m a diehard optimist … 

 Collins: That’s okay. I am too! 

 Everly: … I truly believe that from the greatest adversities, opportunities can emerge. When I spent three years in New York working after the 9/11 terrorist attack, I thought this is the defining moment, not just of my generation, but of others. I got to see it up close and personal, and worked intimately with various agencies. And I did see opportunities. As a result of 9/11, we changed not just the way we go through airports, but the way we look at trauma from a public health standpoint. Perhaps for the first time, we realized that we need to take a far more active preventative and interventional role. Now, history repeats itself. I believe that this pandemic will change us for the rest of my life—and I don’t think all those changes need be negative. I think there are huge opportunities. I certainly am eager to investigate this at the highest levels of science. Let’s see why things work when they work and why things don’t work. Then, let’s use that information to build programs and test them in randomized, controlled trials. I think we will come out of this pandemic better than we went into it. I would encourage people to understand that we’re in this together. Way back in the mid-1800s, Darwin told us that the greatest predictor of resilience was collaboration and cohesiveness. This is a time to reach out to each other. 

 Collins: I totally agree with that. You’re making a really good point: social distancing doesn’t have to mean anything more than physical distancing. We can stay socially close and reach out to each other in different ways. We’re going to get through this, but get through it in a way that will change us. We will be changed by becoming stronger and more resilient, having learned some lessons about ourselves and about each other. We cannot simply hide our heads under our pillows and wait for this to pass. When you wake up in the morning, say to yourself: “I’m engaged in something that matters. I’m not just a passive victim of this terrible pandemic. I’m trying to do what I can and work toward getting us through.” Many thanks, Professor Everly, for all your good work and for giving us this time to reflect on this important area of research and how to make the most of it.

Sunday, April 19, 2020

Anxiety Coping Mechanisms - In The Age of Social Distancing

Kat Schneider - April 19, 2020 - The New York Times
I started therapy last year for post-traumatic stress disorder and anxiety. It took a few tries before I felt comfortable, but thankfully, I stuck with it and learned a few coping methods that have proven especially helpful during social distancing.

Saturday, April 4, 2020

Why Talking About Our Problems Helps So Much (and How to Do It)

There’s more to the age-old advice to just “talk it out” than there seems. Here’s some of the evidence that explains why it is so helpful.

By Eric Ravenscraft     The New York Times
·        April 3, 2020

When your car breaks down, you either know how to fix it or how to find someone who can. Emotions, on the other hand, are a little harder to fix. There is no wrench you can grab or repair shop you can take your feelings to. But you do have one tool in your kit you can always use: talking about your feelings. Even just speaking about your feelings out loud to another person can help. So why do we avoid it or believe it doesn’t work? 

There are a lot of reasons talking about our problems can be difficult. Some people (especially men) are socialized to internalize feelings, rather than give voice to them. Sometimes the very emotions you’re dealing with — like guilt over something you did, or shame about how you think you’re perceived — can feel so overwhelming that you can’t get up the motivation to talk it out.

Regardless of the reason you might keep it in, talking has powerful psychological benefits that might not be obvious. “Talking about it” is a broad phrase, though, so let’s clarify a bit. When we discuss talking about your problems, it can take a few forms.

Venting to a trusted friend. Sometimes you just need to let out how you’re feeling with no real plan for a solution. “I had the worst day at work!” can be the start of a conversation that helps you process the stress of a hard day.

Discussing a conflict with a partner. Fights happen in relationships. But keeping your feelings to yourself can cause issues between you and your partner to fester. While working toward constructive solutions to your relationship problems is always a good thing, just being able to be open about your feelings with your partner can make your communication healthier as well.

Talk therapy with a licensed therapist. There’s a reason people will pay money to talk through problems with a therapist. Whether you need to discuss a mental illness you’re struggling with, are in couples counseling to work on your relationship or just need someone to talk to who knows how to handle stress, a good therapist can help you hash out your emotions.

Being open about your struggles. Sometimes venting to no one in particular can help not just you, but others as well. For example, in 2015 Sammy Nickalls, a writer, started the social media hashtag #TalkingAboutIt to encourage people to be open about their struggles with mental illness. The act of sharing what daily life is like can help you and others with the same struggles realize that you’re not alone and that what feels overwhelming is actually normal.

What all of these forms have in common is that they are conversations specifically designed to examine and express the emotions you are having, rather than building to a specific solution. Figuring out things you can do to improve your situation is certainly good, but just verbalizing how you’re feeling can, itself, be part of the solution as well.

Why does talking about it help?

Getting a new job, breaking up with a bad partner or investing in your own self-improvement are all practical things you can do to solve problems in your life. But what good does just talking about it do? When you’re fighting the exhausting uphill battle against your own negative feelings, it can seem as if talking about it is the least productive thing you can do.

In reality, your brain and body get a lot out of talking.

When you are feeling very intense feelings — especially fear, aggression or anxiety — your amygdala is running the show. This is the part of the brain that, among other things, handles your fight or flight response. It is the job of the amygdala, and your limbic system as a whole, to figure out if something is a threat, devise a response to that threat if necessary, and store the information in your memory so you can recognize the threat later. When you get stressed or overwhelmed, this part of your brain can take control and even override more logical thought processes.

Research from U.C.L.A. suggests that putting your feelings into words — a process called “affect labeling” — can diminish the response of the amygdala when you encounter things that are upsetting. This is how, over time, you can become less stressed over something that bothers you. For example, if you got in a car accident, even being in a car immediately afterward could overwhelm you emotionally. But as you talk through your experience, put your feelings into words and process what happened, you can get back in the car without having the same emotional reaction.

Research from Southern Methodist University suggested that writing about traumatic experiences or undergoing talk therapy had a positive impact on a patient’s health and immune system. The study argues that holding back thoughts and emotions is stressful. You have the negative feelings either way, but you have to work to repress them. That can tax the brain and body, making you more susceptible to getting sick or just feeling awful.

None of that is to say that talking about your problems, or even talk therapy with a licensed therapist, will automatically fix everything and immediately make you happy and healthy. But, like eating better and exercising, it can contribute to overall improvement in your well-being. More important, it can help you understand how and why you feel the way you do, so you can handle your emotions more effectively in the future.

How can we do it better?

Crucially, not every form of talking about problems aloud can help. In fact, multiple studies examining college studentsyoung women and working adults suggest that co-rumination — or consistently focusing on and talking about negative experiences in your life — can have the opposite effect, making you more stressed and drawing out how long a problem bothers you. To talk about your problems more constructively, there are a few key things you can do.

Choose the right people to talk to. If you’ve ever talked about how you’re feeling and it seems as if you got nothing out of it, you might be talking to the wrong person. Having a trusted friend who will support you (without enabling bad habits like co-rumination) can help. If you need specific advice on a problem, find someone who has faced similar problems and, ideally, has resolved them. And if you need a lot of talk time, try spreading your conversations out to multiple people. One person can get worn out, and having a broad social support system lets you distribute that load.

Choose the right time to talk. Just as important as choosing who to talk to is when you talk to them. Your friends may want to support you, but they have their own lives. Asking if they have the time and energy to talk before unpacking your emotional bags can help you both be better equipped for the conversation. This also means being courteous about their time. Sometimes crises happen and you might need to interrupt someone, but most supportive conversations can wait.

Find a therapist, even if you’re not mentally ill. Therapists often have a reputation for being necessary only if you have a mental illness. This isn’t the case. You can go to therapy if you are feeling overly stressed, if you are not sleeping well or if you just want someone to talk to. Think of it less like seeing a doctor and more like a personal trainer. Also, remember that just as with doctors, mechanics or anyone else you hire, there are good ones and bad ones (or bad ones for you), so if you don’t have success the first time, try someone else.

Give yourself an endpoint. Not all conversations about your problems need to lead to a plan of action for tangible change, but they do need to lead to something other than more complaining. Give yourself space to vent about your feelings and, while doing so, focus on how you are feeling throughout the process. If you are getting more worked up, take a break. If you find yourself talking about the same things over and over without gaining any new understanding or feeling any relief, try something else to process how you are feeling. You may not be able to fix the external problem that is bothering you, but the goal should at least be to improve your mood about it.

Talk about the good as well as the bad. Expressing how you’re feeling is healthy. Expressing yourself only when you feel bad isn’t. Whether you are talking to friends, partners or on social media, be sure to share your good experiences and feelings when they come up. Talking about these experiences can reinforce them in your brain and make it easier to break out of negative thought patterns later. Plus, it helps build your relationships with the people you are close enough to talk to.

Of course, this process can still be messy. Some days, talking about your problems may just be complaining about something that happened at work, but others it may involve crying into someone’s shoulder for an hour. It can feel embarrassing or uncomfortable the first few times, but the more you open up, the easier it will get to share how you feel.

Thursday, April 2, 2020

4 Ways to Help Your Anxious Kid

First, acknowledge ways the coronavirus has changed their lives.

When I spoke to her for last week’s newsletter about long-term effects of the coronavirus pandemic on children, Rahil Briggs, Psy.D., mentioned the metaphor of the dandelion and the orchid. It’s a theory developed by Dr. Thomas Boyce, M.D., a pediatrician and researcher, and it posits that the vast majority of children are “dandelions” — pretty resilient and able to deal with stress as it comes.
But, Dr. Boyce estimates about 20 percent of children are “orchids.” As he described them on NPR’s “Fresh Air” in 2019, “the orchid child is the child who shows great sensitivity and susceptibility to both bad and good environments.” They may be more sensitive because of a combination of biological and environmental reasons.
You know if you have an orchid, and he may be struggling more than usual right now, with all of the changes this pandemic has wrought on his quotidian life. Dr. Boyce’s research shows that orchids thrive on regular routines — routines that have had to be rejiggered considerably in the past month or two. I spoke to experts about what you can do to help your anxious children right now. Though these methods are geared toward orchids, they can work on your upset dandelions as well.
Label what’s happening. Just acknowledging the recent changes to your children’s lives can feel validating, said Becky Kennedy, Ph.D., a clinical psychologist in New York City. “With young kids, you can keep an ongoing list of things that have changed and things that have stayed the same,” Dr. Kennedy said. Brainstorm this list verbally with your kids — for example, “You used to go to a school building, that has changed, but you still have Mommy tucking you in every night, that’s the same.” By doing so, it will make them feel less alone in their feelings, because they’ll know they’re not the only one noticing that things aren’t the way they used to be.

Resolve your own anxiety. We have given this advice before, so apologies for being a broken record. But several of the experts we spoke to emphasized that parents’ anxiety can make kids feel unsettled. “Our kids are brilliant emotional detectives of their parents,” said Abi Gewirtz, Ph.D., a clinical psychologist and professor at the University of Minnesota, and the author of the forthcoming book, “When the World Feels Like a Scary Place: Essential Conversations for Anxious Parents and Worried Kids.” If you are showing your anxiety, “it can leach out into interactions” with your children, Dr. Gewirtz said. The Times put together 10 tips for easing your anxiety. (Ten Tips Link)
Teach children mindfulness techniques. Progressive muscle relaxation — where you tense and then release individual groups of muscles — can be helpful for anxious kids, said Dunya Poltorak, Ph.D., a pediatric medical psychologist in private practice in Birmingham, Mich. The University of Washington has a progressive muscle-relaxing script just for little ones (Script Linkthat you can read to your children. GoZen!, an organization that helps children manage their anxiety, has a YouTube video that can also help guide your kids through progressive muscle relaxation.
Another behavioral technique that can make children feel better is deep breathing, Dr. Poltorak said — here are some deep breathing exercises from Jamie, our Cosmic Kids Yoga queen. (Cosmic Kid Link)
Create a schedule with pictures. Predictability is very important for anxious children, said Sally Beville Hunter, Ph.D., a clinical assistant professor at the University of Tennessee, Knoxville, and one way to soothe kids who don’t read yet is to make a schedule that has images depicting the routine of the day. “I don’t think having really detailed schedules is necessary or even helpful,” Dr. Hunter said. We’re all overwhelmed right now, so don’t worry about making some elaborate plan that would be impossible to execute. “It can be as simple as, here are four things we do every day”: breakfast, lunch, dinner, cuddles.

9 Books to Help Calm an Anxious Toddler

These days, anxiety is on the rise in all age groups, and toddlers are not immune. Children’s books publishers have responded to the spike by producing more books aimed specifically at helping kids cope with all this ambient anxiety.
This brilliant board book invites a child to “help” someone else who’s hurting — which works wonders to induce a calmer state of mind. Little Rabbit has fallen down and scraped his arm, leaving a red mark. Your toddler is invited to “try blowing on it.” Uh-oh: On the next page, Little Rabbit wails, “There’s blood!” A Band-Aid (with bunnies on it, of course) appears. “Can you put it on?” comes next, but tears still stream down the distressed bunny’s face. And so on, until the bunny feels better — and, chances are, your toddler does too.
The esteemed creator of “Strega Nona,” who has practiced meditation for years, has made this beautifully spare picture book that teaches mindfulness to children in a non-preachy way. A grandfather, two grandchildren and a dog watch what’s around them: bees on a patch of flowers, a praying mantis climbing a lily stalk, a mother fox curled with her young in a hidden den. “My, oh my,” the grandfather says. “Everything is in such a hurry.” The family sits on a bench in order to relax, notice, see deeper and describe: a recipe for a peaceful state of mind.
Full of soft, detailed illustrations, this is another good book to help a kid slow down and become more mindful. It starts with an inarguable statement: “Right here, right now, you are reading this book.” Then it calls attention to events occurring elsewhere: ants building, ideas forming, animals living and breathing. One breathtaking spread shows an airplane carrying people, other people sitting below in a field, and the earthworms, fossils and rocks beneath them.
Inspired by Milne’s own daughter’s struggles with anxiety and repetitive behaviors, this charming tale features a habit-bound dachshund who is called upon to rescue a friend stuck in a pipe. His success makes him so happy, he dares to vary his routine — just a little bit, at first. Little ones controlled by worries may find a ray of light in this pup’s small victory.
The poofy red creature in this wise book is here to demonstrate a crucial life lesson that can help small children with social anxiety: Go ahead and put yourself out there — what Castillo calls a Ping — but remember, you can’t control how other people will react — the Pong. The creature Pings by painting, singing and “expressing feelings that just need to burst out.” Then it’s time to breathe deeply, listen for Pongs and decide what to do in response. So many books these days offer kids social-emotional counsel; this one delivers down-to-earth ideas in a refreshingly direct package.
For an agitated toddler, this lovely book is like a cool drink of water on a hot day. A child named Taylor, who’s wonderfully drawn to be either a boy or a girl, builds a block tower that falls down. Everyone who comes by to help, including a chicken and an elephant, is full of well-meaning advice. Only a silent rabbit offers what Taylor — like all of us — needs: the comfort of someone who will just listen, laugh and give a hug.
Reading poetry, with its rhythm, repetition and incantational power, is a great way to create a mood of reassurance for an anxious child. This playful collection for children from the distinguished poet Nikki Giovanni and the distinguished illustrator Ashley Bryan focuses on the most reassuring thing of all — love — without being mushy. The short poems float by like feathers, encouraging children to tune into their own self-love as well as the embrace of their families and communities. Bryant’s colorful artwork is warm and welcoming.
Most people are good: That’s the simple message of this deeply reassuring book, and it couldn’t be more timely, given the conflict, stress and negativity even the littlest kids pick up from the grown-up world these days. Most people, we are reminded, also love to smile and want to help other people — in fact, there are many, many more good people than bad ones. There’s also a story unfolding here, as two characters play out the words we are reading.
Sometimes a serene and philosophical picture book is just the thing to improve a frazzled mood and set the world right. In this one a bear and a wolf, out for nighttime walks, cross paths and decide to hike together, first through snowy winter vistas, then later through green springtime fields. Nothing much happens. Their peaceful companionship and mutual appreciation of sublime natural beauty are more than enough.

Monday, March 30, 2020

Breathe. Exhale. Repeat: The Benefits of Controlled Breathing

Breathe. Exhale. Repeat: The Benefits of Controlled Breathing 

By LESLEY ALDERMANNOV. 9, 2016   -   The New York Times

Take a deep breath, expanding your belly. Pause. Exhale slowly to the count of five. Repeat four times. 

Congratulations. You’ve just calmed your nervous system. 
Controlled breathing, like what you just practiced, has been shown to reduce stress, increase alertness and boost your immune system. 

For centuries yogis have used breath control, or pranayama, to promote concentration and improve vitality. Buddha advocated breath-meditation as a way to reach enlightenment. 

Science is just beginning to provide evidence that the benefits of this ancient practice are real. Studies have found, for example, that breathing practices can help reduce symptoms associated with anxiety, insomnia, post-traumatic stress disorder, depression and attention deficit disorder. 

“Breathing is massively practical,” says Belisa Vranich, a psychologist and author of the book “Breathe,” to be published in December. “It’s meditation for people who can’t meditate.” 

How controlled breathing may promote healing remains a source of scientific study. One theory is that controlled breathing can change the response of the body’s autonomic nervous system, which controls unconscious processes such as heart rate and digestion as well as the body’s stress response, says Dr. Richard Brown, an associate clinical professor of psychiatry at Columbia University and co-author of “The Healing Power of the Breath.” 

Consciously changing the way you breathe appears to send a signal to the brain to adjust the parasympathetic branch of the nervous system, which can slow heart rate and digestion and promote feelings of calm as well as the sympathetic system, which controls the release of stress hormones like cortisol.

Many maladies, such as anxiety and depression, are aggravated or triggered by stress. “I have seen patients transformed by adopting regular breathing practices,” says Dr. Brown, who has a private practice in Manhattan and teaches breathing workshops around the world. 

When you take slow, steady breaths, your brain gets the message that all is well and activates the parasympathetic response, said Dr. Brown. When you take shallow rapid breaths or hold your breath, the sympathetic response is activated. “If you breathe correctly, your mind will calm down,” says Dr. Patricia Gerbarg, assistant clinical professor of psychiatry at New York Medical College and Dr. Brown’s co-author 

Dr. Chris Streeter, an associate professor of psychiatry and neurology at Boston University, recently completed a small study in which she measured the effect of daily yoga and breathing on people with diagnoses of major depressive disorder. 

After 12 weeks of daily yoga and coherent breathing, the subjects’ depressive symptoms significantly decreased and their levels of gamma-aminobutyric acid, a brain chemical that has calming and anti-anxiety effects, had increased. The research was presented in May at the International Congress on Integrative Medicine and Health in Las Vegas. While the study was small and lacked a control group, Dr. Streeter and her colleagues are planning a randomized controlled trial to further test the intervention. 
“The findings were exciting,” she said. “They show that a behavioral intervention can have effects of similar magnitude as an antidepressant.” 

Breathing may also affect the immune system. Researchers at the Medical University of South Carolina divided a group of 20 healthy adults into two groups. One group was instructed to do two sets of 10-minute breathing exercises, while the other group was told to read a text of their choice for 20 minutes. The subjects’ saliva was tested at various intervals during the exercise. The researchers found that the breathing group’s saliva had significantly lower levels of three cytokines that are associated with inflammation and stress. The findings were published in the journal BMC Complementary and Alternative Medicine in August. 

Here are three basic breathing exercises to try on your own. 

Coherent Breathing 

If you have the time to learn only one technique, this is the one to try. In coherent breathing, the goal is to breathe at a rate of five breaths per minute, which generally translates into inhaling and exhaling to the count of six. If you have never practiced breathing before, you may have to work up to this practice slowly, starting with inhaling and exhaling to the count of three and working your way up to six. 

1. Sitting upright or lying down, place your hands on your belly. 
2. Slowly breathe in, expanding your belly, to the count of five. 
3. Pause. 
4. Slowly breathe out to the count of six. 
5. Work your way up to practicing this pattern for 10 to 20 minutes a day. 

Stress Relief 

When your mind is racing or you feel keyed up, try Rock and Roll breathing, which has the added benefit of strengthening your core. 

1. Sit up straight on the floor or the edge of a chair. 
2. Place your hands on your belly. 
3. As you inhale, lean forward and expand your belly. 
4. As you exhale, squeeze the breath out and curl forward while leaning backward; exhale until you’re completely empty of breath. 
5. Repeat 20 times. 

Energizing HA Breath 

When the midafternoon slump hits, stand up and do some quick breathwork to wake up your mind and body. 
1. Stand up tall, elbows bent, palms facing up. 
2. As you inhale, draw your elbows back behind you, palms continuing to face up. 
3. Then exhale quickly and thrust your palms forward and turning them downward, while saying “Ha” out loud. 
4. Repeat quickly 10 to 15 times. 

YouTube: 5 Minute Breathing Exercise

YouTube: Neck and Shoulder Exercises at Home

YouTube: Progressive Muscle Relaxation

Saturday, January 12, 2019



Give up the rat race, accept reality and have the courage to be disliked – the latest self-help trend is not about self-reinvention but finding contentment in the life you have

The Guardian
Sat 12 Jan 2019 03.59 EST

By tradition, this is the season for personal reinvention, but these days it’s hard not to feel cynical about the idea of a triumphant liberation from the past. In the news, Brexit provides an hourly reminder that merely wishing to bring about a glorious fresh start is no guarantee that calamity won’t be the result. Meanwhile, other dark developments – from the erosion of American democracy and the resurgence of the European far right, all the way to climate change – fuel a sense of foreboding that isn’t exactly motivational when it comes to self-improvement: the creeping fear that you might be living in the end times is a poor basis for making a new beginning. In any case, the never-ending debate on nature versus nurture seems to be drifting toward a gloomy acceptance that there’s much about ourselves we’ll never change. “DNA isn’t all that matters,” writes the geneticist Robert Plomin, whose book Blueprint epitomised this mood last year, “but it matters more than everything else put together in terms of the stable psychological traits that make us who we are.”

Then again, the self-reinvention narrative was always a bit suspect to begin with. For one thing, it’s by no means clear that it’s possible to transform yourself through the simple application of individual willpower: wherever you come down on nature and nurture, it’s undeniable that we owe much of our success or failure in life to our circumstances, and to luck. Then there is the infuriating psychological quirk of “hedonic adaptation”, otherwise known as the happiness treadmill. Succeed in improving your life, and the improvement will soon become part of the backdrop of your days, and thus cease delivering pleasure; to recover that sense of vitality and zest, you’ll have to reinvent yourself again, ad infinitum.
Finally, there’s the conundrum that the self being reinvented is the same one that’s doing the reinventing – so your existing flaws invariably get baked into your vision of the future. If you yearn to become, say, more productive or empathetic or physically fit in 2019, how do you know that very yearning isn’t just another expression of your tendency to beat yourself up, which you’d be better off addressing than indulging? Or suppose you plan to conquer your perfectionism: how will you avoid getting all perfectionistic about that? There are no completely fresh starts, there is no year zero. You’re already hopelessly ensnared in the only life you’ll ever get.

In response to the prevailing mood, there has been a noticeable change of tone in the world of self-help, a publishing genre historically dedicated to promising massive, near-effortless transformation overnight, or in a couple of weeks at most. For a while now, that hyperbole has been losing ground to a spirit of anti-utopianism – of accepting yourself as you are, building a good-enough life, or just protecting yourself from the worst of the world outside. Adult colouring books are the most easily mockable manifestation of this urge. But it’s detectible, too, in the unceasing stream of Scandinavian lifestyle concepts – hyggelagom, and the rest – with their focus on hunkering down and getting cosy; and in the ongoing rediscovery of Stoic philosophy and the championing of “resilience” as techniques for enduring life’s blows.

And it’s everywhere present, this time around, in the phase of the publishing calendar irritatingly known as “New Year, New You”. One thought-provoking example is a new edition of Solve for Happy by Mo Gawdat, formerly a senior executive with Google X, the search giant’s secretive research and development arm. Generally speaking, the notion that “happiness is an engineering problem” is one to distrust. But Gawdat, far from championing the tech multimillionaire lifestyle as the only one worth aiming for, writes movingly of having achieved it, only to discover its emptiness. And he has endured far worse, losing his 21-year-old son Ali as a result of complications during routine surgery. 
The hyperbole of overnight transformation has lost ground to a spirit of anti-utopianism – of accepting yourself as you are

At the core of Gawdat’s “formula for happiness” is the venerable observation that happiness equals reality minus expectations: in order to feel distress because your life is lacking something, you must first have had some expectation of attaining that thing. (My life lacks a 70ft yacht, but this causes me no suffering, because I never imagined I’d have one.) The argument is not, as progressive critics of self-help sometimes imagine, that disadvantaged people need only stop expecting anything better in order to be content. Some expectations – a reasonable standard of living, healthcare, fulfilling work, social connection – may be entirely rational. But seeing the truth of the formula acts as a kind of sieve, allowing you to separate the handful of things you genuinely want from life from those you’ve been socialised into believing you should want. The latter aren’t worth the pursuit – and if they are the reason you’re trying to invent a “new you”, you’re better off sticking with the old one.

One of the most rigorous articulations of the new mood of acceptance is Happy Ever After: Escaping the Myth of the Perfect Life by Paul Dolan, a professor of behavioural science at the LSE and, the publicity material explains, “an internationally renowned expert in human behaviour and happiness”. His book is a persuasive demolition of many of our cultural stories about how we ought to live, including the idea that there’s anything particularly desirable about being a senior academic or a renowned expert. In fact, his data suggests, pursuing education beyond the age of 18 is unlikely to make much positive difference to the pleasure or sense of purpose you experience in life: on average, after secondary school, “happiness decreases as education increases”.

As Dolan concedes, it can be notoriously hard to pin down the direction of causation in wellbeing research: it could be that gloomier people are more prone to doing university degrees, rather than that degrees make people gloomy. Yet either way, the belief that more education equals more fulfilment is a clear example of what he calls a “narrative trap” – a socially imposed message about the ideal life that doesn’t match real experience. This ideal often ends up doing more harm than good, either by propelling people into lives they don’t enjoy, or by wrongly convincing those who don’t make the grade that they are missing out on a more satisfying existence. Another trap is the belief that higher-status jobs reliably bring more satisfaction (in fact, florists are generally much happier than lawyers), or that a larger income necessarily buys more happiness (it does, but only up to about £50,000 a year; beyond that, tasks related to earning more money squeeze out more enjoyable ones).

These sorts of findings are increasingly well known, but where Dolan excels is in drawing attention to how stubbornly we resist their implications. If happiness and a sense of purpose are your goals in life, then a “good job” or education or salary that fails to deliver them isn’t really “good” in any meaningful sense of the word – which makes it a strange thing to strive for, or to encourage your children to strive for. Oh, and speaking of children, the evidence is that parenthood won’t make you happier, either. (It does boost people’s sense of purpose, although apparently not more than various other things.) Likewise the dedicated pursuit of physical fitness, which turns out to lead to less happiness than you’d think. And marriage: it’s true that married people tell researchers they are happier than when they were single, but only if their husband or wife is present in the room during the interview. 

The message of self-reinvention is never relax, since you could always benefit from acquiring more money and status

What makes Happy Ever After somewhat radical, at least by the standards of popular psychology, is its recognition that these narrative traps aren’t simply inexplicable mistakes we happen to make, but the products of ideology. They may not serve us, but they certainly serve the system in which we find ourselves embedded. The pursuit of wealth or social mobility might not bring happiness, but it does fuel economic growth – while marriage, parenthood, fitness and the rest keep the whole operation running smoothly into the next generation. Dolan focuses on how uniquely detrimental such messages can be for children from working-class families. Stereotypes about appropriate accents and lifestyles may deter them from going to university at all; those who make it into middle-class professions then face self-consciousness and insecurity about fitting in. Dolan, raised “lower working class” in east London, writes that he still struggles with the cultural codes of academia: “I weight train with bodybuilders. Seeing a blazer or a pair of loafers at a bodybuilding competition is as rare as rocking-horse shit.”
The new crop of anti-perfectionist self-help books are an important counterweight to the conventional message of self-reinvention, which is that there’s no point at which it makes sense to be satisfied with your situation and finally relax, since you could always benefit from acquiring more money, status, education, and so on. What’s less clear is whether this humbler kind of advice is any easier to implement, on a practical level, than the old sort. Apart from anything else, our narratives about the perfect life aren’t just beliefs we can choose to jettison by a mere act of will, after reading about research that refutes them. They are deeply entrenched in the culture, reinforced by the media, inculcated in us as small children, not to mention in our genes. (There are some obvious evolutionary advantages to constantly craving more resources, and never feeling as if what you’ve got is sufficient.) Moreover, no research finding about the average happiness of the general population can decisively prove that a given lifestyle choice is the right or wrong one for you, with all your idiosyncrasies. One chapter in Happy Ever After gamely makes the case for polyamorous relationships as a path to increased happiness, but whatever your reaction to that prospect – thrilling erotic adventure, or indescribable hassle? – it’s not clear that you should try to override it based on the results of academic studies.

There’s another, more mind-bending problem with using this kind of research to direct personal change, which is that many such transitions are what the philosopher LA Paul calls “transformative experiences”: they turn you into a person so different that you’re unable, from the vantage point of the present, to imagine what that future person will make of them. To pick the most obvious example, becoming a parent might transform you into the kind of person who adores having children, even if beforehand you weren’t. But it might just as easily work the other way, turning someone enthusiastic about the prospect into the kind who’d never have chosen to do so.

Nonetheless, it’s psychologically freeing to be reminded that there is no single path to satisfaction – and that if circumstances or personal preferences disbar you from following the herd, you still have a good shot at fulfilment. “Quite a lot of what passes itself off as dialogue about our society,” the essayist Tim Kreider has written, “consists of people trying to justify their choices as the only right or natural ones by denouncing others’ as selfish or pathological or wrong. So it’s easy to overlook that hidden behind all this smug certainty is a poignant insecurity, and the naked 3am terror of regret.” Much of the time, when it comes to building a meaningful life, you’re flying blind. But the comforting truth is that so is everyone else.

Then again, judging by its continued dominance of the self-help shelves, you’d be forgiven for concluding that the key to a perfect life was indisputable: lots and lots of Buddhist (or at least Buddhist-inspired) meditation. This is ironic, since Buddhism embodies one of the earliest confrontations with the truth about the perfectionist standards by which we judge the world and ourselves – that this is a recipe for permanent dissatisfaction. The basic situation, Buddha famously said, is that life is suffering. Everything is impermanent; old age, sickness and death are our inescapable human fate. And your philosophy of happiness had better acknowledge these realities, otherwise the only possible result is even more suffering, for you and everyone around you.

While he probably wouldn’t put it so bluntly, this is the spirit that imbues a new work by the South Korean Zen writer and former monk Haemin SunimLove for Imperfect Things: How to Be Kind and Forgiving Toward Yourself and Others. In these snark-saturated times, it’s cheering that a voice as quietly friendly as Haemin’s can make you a mega-celebrity: he has a combined social media following of around 2 million people, plus a previous global bestseller, The Things You Can See Only When You Slow Down. (In Seoul, where he lives, he presides over a Zen-infused therapy centre, the School for Broken Hearts, but the primary vehicle for his teaching is Twitter.)

Haemin is especially eloquent on life’s smaller dissatisfactions, and how they can sometimes be trickier to deal with than the bigger, more dramatic ones. For example, though it’s a good thing that we talk so much more openly today about mental illness, one perverse consequence is that it can actually be easier to admit to a serious depression than to a milder, pervasive sense of disappointment in life. “Unlike other emotions, disappointment is very tricky to express: it comes out as petty and small-minded,” Haemin writes; it also tends to sound like you’re blaming other people for failing to measure up. Yet of course it’s a far more widespread problem than severe suffering. It has been argued that Buddha’s observation that “life is suffering” might be more accurately translated as something like “life is bothersome”. (With luck, extreme agony will be very infrequent in your life, but a background sense of things being not quite right may be truly close to universal.) The first step towards relieving this kind of discontent, Haemin suggests, is to recognise the untenability of the demand that you, or anyone you encounter, should demonstrate perfection to begin with. Much of the bothersomeness of daily life arises not from circumstances themselves, but from the insistence that they ought to be other than they are.

Having not yet attained Haemin’s tolerance for other people’s flaws, I can’t resist observing that his wisdom all too often comes across as platitudinous. The book’s prose passages are interspersed with sections laid out as blank verse, inadvertently demonstrating that mundane reflections aren’t transformed into profundities merely by centring them on the page and inserting a few line breaks. (A typical example: “If someone did not ask for your help, / do not try to solve her problem for her. / Though your intentions may be good, / You risk taking control away from her / and injuring her self-esteem.”) Still, he’s not wrong. And behind the sporadic banality lurks a bracingly hard-headed world view: reality is what it is, and a lot of unnecessary misery arises from demanding that things shouldn’t be the way that – as a matter of stubborn fact – they are. This is not a counsel of resignation; having accepted the reality of your situation, it may well be appropriate to try to change it. But not denying how things stand is the essential first step. Or, as the psychotherapist Carl Rogers put it: “The curious paradox is that when I accept myself just as I am, then I can change.” 

It can be easier to locate fulfilment in the future, rather than run the risks involved in trying to achieve it now

Ironically, if not very surprisingly, the wellbeing industry has proved adept at turning this new spirit of modesty and acceptance into another expensive consumerist pursuit. Those Scandinavian “secrets of happiness” are a case in point: “hygge” may evoke contended relaxation around a familiar fireplace with old friends, but that doesn’t mean you can’t spend almost £200 on a specially hygge-appropriate plant-dyed pillow, or £80 on a set of candle holders, at the website (And while “lagom” may mean “just the right amount” in Swedish, there are at least six recent books in English on the subject, which isn’t just the right amount, but too many.) Your effort to become the sort of person who finds happiness in what they already have can easily become its own interminable quest, in which success – and therefore happiness – always lies in some fantasy of the future, rather than in the here and now.

As always, this is capitalism’s fault. But most of us are complicit: we chase unattainable fantasies of self‑reinvention, rather than confronting reality, at least in part because life is easier that way. This is one of the lessons of an absorbing recent addition to the anti-perfectionist self-help subgenre, The Courage to Be Disliked, by Ichiro Kishimi and Fumitake Koga, published in English last year. (By then, it had reportedly already sold more than 3.5m copies in the original Japanese and other translations.) Despite all the “new Japanese phenomenon” marketing – the book was described by one critic as “Marie Kondo, but for your brain” – it is primarily an accessible exploration of the work of the Austrian psychotherapist Alfred Adler. He held that we frequently cling to our problems, no matter how much we complain about them and claim we want to eradicate them, because overcoming them necessitates an encounter with fear. It can be easier to locate fulfilment – and fulfilment in intimate relationships above all – in the future, where we never quite have to do what it takes to attain it, rather than run the interpersonal risks involved in trying to achieve it now.

The problem, as Kishimi and Koga make clear, is that this only makes for more suffering in the present, by systematically biasing you towards taking the kind of actions that postpone, rather than build, a meaningful life. In this way, fantasies of total self-transformation don’t simply fail, they also block change of the more modest – but real – kind. And in any case, the future never seems to arrive: the truth is that the present is the only time it’ll ever be possible to make a change. Transformative self-reinvention may be an overoptimistic dream, but defeatism about change is its own kind of false comfort, too: both are forms of absolutism that serve to justify passivity. We will fail to reinvent ourselves this January, or next month, or next January, or ever. But once we finally get that fact into our heads, we might at last be able to start making a few improvements.